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Widen Access to These HIV Drugs, Say Advocates

BC lags in offering long-acting injectable medications that experts say can save lives.

Moira Wyton 20 Mar 2023TheTyee.ca

Moira Wyton is The Tyee’s health reporter. Follow her @moirawyton or reach her by email. This reporting beat is made possible by the Local Journalism Initiative.

Three years since Canada first approved an innovative long-acting drug called Cabenuva to treat HIV, advocates say access to the medication for people living with HIV in B.C. still lags behind the rest of Canada.

AIDS Vancouver is calling on the Ministry of Health and BC Centre for Excellence in HIV/AIDS to fund and increase access to Cabenuva and also recently approved Sunlenca, two long-acting injectable medications that suppress the virus, prevent transmission and extend the lifespans of people who are HIV-positive.

B.C. is also the only province where Cabenuva is not funded through public provincial health coverage.

“People living with HIV die when they don’t have access to treatment that works,” said executive director of AIDS Vancouver Sarah Chown. “What we’re asking for here is people with HIV to be given the dignity and respect to choose what works.”

Providing long-acting injectable medications, given every one to two months, as well as medications as daily pills will help improve patient adherence to treatment, prevent HIV from developing into AIDS and save lives, she said.

Cabenuva was approved for people aged 12 and older by Health Canada in March 2020 and Sunlenca, which must be taken alongside another daily pill HIV treatment, was approved in November 2022. 

Long-acting injectable Cabenuva, a mix of two antiretroviral drugs, is available to patients in B.C. through the BC Centre for Excellence in HIV/AIDS, according to a Friday statement from a Ministry of Health spokesperson. 

The centre, housed by Providence Health Care, has reviewed the drug and is in charge of setting treatment guidelines and covering the drug’s cost with funding it receives from the province.

“Because of the particulars of the drug, this is recommended in very specific clinical circumstances, consistent with the product’s regulatory approval,” wrote the spokesperson in an emailed statement to The Tyee.

“The eligibility criteria for Cabenuva in B.C. will be adjusted as necessary as the evidence evolves.”

A patient’s doctor must send the centre a request on the patient’s behalf after ensuring they meet specific criteria including their lifestyle, ability to adhere, allergies, age and weight, per the centre’s published guidelines. The 12-month prescriptions are approved by the centre on a case-by-case basis and patients’ doctors must apply for them again each year.

Rather than having the drug covered through the provincial Medical Services Plan, the centre decides whether to allocate the funds to cover it for each individual.

The Tyee asked the ministry how many applications the centre has received and how many have been granted since the drug’s approval but did not receive an answer by publication time. The centre also did not respond to a separate request for comment from The Tyee.

“The Ministry of Health is committed to supporting all people with an HIV/AIDS diagnosis and we will continue to work towards ensuring access to life-saving treatments and care remain available to all people in British Columbia,” read the ministry’s Friday statement to The Tyee.

But Chown says B.C.’s guidelines are too narrow and haven’t facilitated access to Cabenuva on the scale required. 

Her organization and others including the Afro-Canadian Positive Network, Community-Based Research Centre and Health Initiative for Men have written to the centre to ask why the drug isn’t more available, only to be directed back to its published guidelines.

She says they don’t appear to be facilitating meaningful access to Cabenuva for people in B.C. No one she’s spoken to has been able to access the medication.

“People have tried to access it and have been denied coverage,” she said. “And they’re turning to us and asking, ‘My friend in Alberta got this, so why can’t I?’”

Long-acting injectable HIV therapies are lower maintenance and improve adherence, the single most significant factor in a medication’s success at treating and suppressing HIV below communicable levels. When taken correctly, they can be up to 99 per cent effective. 

The medications, also used to prevent HIV, have made it so being HIV-positive is no longer a certain sentence to dying of AIDS. AIDS has killed more than 40 million people worldwide and first began to infect Two-Spirit people and men who have sex with men in Canada and the United States in the early 1980s.

About 63,000 Canadians live with HIV, according to Statistics Canada. There are about 1,500 new infections each year, a rate that has stagnated in recent years after decades of scientific progress in part led by B.C.’s Centre for Excellence.

More than half of people living with HIV would be interested in a long-acting injectable treatment over a pill, according to a recent survey of 2,400 people living with HIV conducted by AIDS Vancouver.

About one-third of HIV-positive people said they felt stressed by the need to take their medication every day, according to the survey. Taking a pill brings up negative memories and emotions for about 35 per cent of survey respondents, and 38 per cent worry the burden could inadvertently expose their HIV status.

Making these shots an option will give people who are unhoused or in an abusive relationship the privacy needed to adhere to the treatment and to avoid stigma and discrimination that could result in violence or losing their housing or employment, Chown said. 

Young people born HIV-positive and their parents also might not want to tell the youth’s friends or parents why they have to take a pill every day at a sleepover, sports tournament or school trip.

And people living in rural and remote areas without regular access to a doctor or pharmacy may also appreciate having a more predictable schedule to plan transportation and child care. 

“The more options that are available, the more it’s going to fit different people’s schedules and lifestyles,” said Michael Montess, a postdoctoral associate at Western University, in a previous interview about long-acting preventative HIV medications. “So more people are going to be able to actually access it, use it effectively, and then stop the negative health outcomes that they are interested in stopping.”

Even though not everyone will be a good fit for the injectable drug, increasing access will help patients make informed decisions, Chown said.

“People with HIV are asking about it, ‘Can you help me understand why we don’t have it in B.C.?’” said Chown. “And I don’t have the answer.”  [Tyee]

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